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Safe zone for the superior gluteal nerve in the transgluteal approach to the dysplastic hip: intraoperative
Masahiko Ikeuchi1, Teruhiko Kawakami, Norio Yamanaka
1Department of Orthopaedic Surgery, Kochi Medical School, Kochi University. Nankoku, 783-8505. Japan. ikeuchim@med.kochi-u.ac.jp
Background:
The superior gluteal nerve can be damaged during the transgluteal approach to the hip in total hip arthroplasty.
Methods:
We studied 30 patients with hip dysplasia who underwent total hip arthroplasty through the transgluteal approach. The course of the inferior branch of the superior gluteal nerve was identified using a nerve stimulator. The distance between the nerve and the tip of the greater trochanter was measured.
Results:
The mean distance was 37 (25-45) mm at the anterior third, 40 (30-50) mm at the middle third, and 44 (35-55) mm at the posterior third of the gluteus medius. The distance was influenced by the severity of hip dysplasia and decreased as the degree of hip dysplasia became more severe.
Interpretation:
A 3-cm safe zone is appropriate in most dysplastic hips. In severely dysplastic hips, however, the superior gluteal nerve occasionally coursed within 3 cm of the tip of the greater trochanter. In such hips, a nerve stimulator can be used to identify the nerve.